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Duchenne muscular dystrophy is a hereditary progressive neuromuscular disorder. Deterioration and weakening of the muscles is also present in orofacial muscles. Both weakness of the muscles and the fact that patients become more dependent of care, can make oral care more difficult. At this moment, it is unknown how patients with Duchenne muscular dystrophy experience their oral health and which problems regarding oral health and oral care may impact their oral health related quality of life. In this cross-sectional study, we found that, despite a high percentage of gingivitis, a high percentage of patients who experience halitosis and a high percentage of malocclusions, patients score their oral health related quality of life as good.

Attempts to decrease socioeconomic health disparities face various challenges, which include ethical questions about prioritization and value-conflicts. To deal with these questions in a way that takes equal standing as a central value, this paper explores the potential of a relational egalitarian capability approach to local health equity policies. Especially for local health equity policies, a relational egalitarian capability approach seems promising as it offers more perspectives for action and evaluation additional to considerations of distributive justice. To scrutinize if this approach can offer an adequate normative basis for health equity policies and be a helpful ethical guide in practice, five desiderata are identified that a relational egalitarian capability approach to local health equity should fulfil. These desiderata stem from a consideration of political-ethical pluralism and scarcity of time and resources as non-ideal conditions characterizing public policy practice, as well as of three questions that any capability approach should answer to be applicable in practice. For each of the five desiderata, a brief outline is given of what relational egalitarian theories and the capability approach offer in response to the questions implied by these desiderata. Ultimately, these questions need to be answered in relation to specific policies in particular contexts., (© 2021 The Authors. Bioethics published by John Wiley & Sons Ltd.)

From the perspective of social justice and equality of opportunity, it is an important yet difficult aim of local governments to enhance the opportunity to be healthy among disadvantaged groups. Apart from a lack of knowledge about effective interventions, there can be uncertainty about what is morally the best thing to do. To get a better understanding of what these moral challenges are, we made an inventory of the ethical dilemmas faced by employees of the public health department of the Dutch City of Utrecht in their aspiration to achieve health equity. Based on both four structured discussions of these dilemmas with municipality employees, and central ideas and distinctions from the philosophical literature on social justice, we formulate five insights on what it means to take equality of opportunity as ideal in local public health policy. That is, 1) fostering equal opportunities to be healthy demands that moral choices are made within policy practice and the execution of policies; 2) fostering equal opportunities to be healthy demands a balancing act between realism and idealism; 3) substantial equality of opportunity in health demands more than formal opportunity; 4) fostering equal opportunities to be healthy works best by giving priority to the worst-off; 5) fostering equal opportunities to be healthy requires paternalism. These insights, together with the structuring questions, can support local policymakers in public health in the decisions they need to make, by clarifying which considerations contribute to health equity., (© The Author(s) 2022.)

Whereas theories on health generally argue in favor of one specific concept, we argue that, given the variety of health practices, we need different concepts of health. We thus approach health concepts as a Wittgensteinian family of thick concepts. By discussing five concepts of health offered by (philosophical) theory, we argue that all capture something that seems relevant when we talk and think about health. Classifying these concepts reveals their family resemblances: each of these concepts differs from the others in at least one respect and resembles the others in several respects. Moreover, our classification shows that "health" always both describes a condition and evaluates that condition at the same time. Having both descriptive and evaluative dimensions, we can see health concepts as "thick concepts." It is because of this evaluative dimension that it is important to reflect on the question of what understanding of health guides specific practices. We show that the distinctions revealed by our classification can serve as a conceptual toolbox for reflection on the assumptions and purposes of particular health practices. Finally, we illustrate how such reflection could work out by briefly exploring three specific health practices.

Objectives: The legitimacy of policies that aim at tackling socioeconomic inequalities in health can be challenged if they do not reflect the conceptualisations of health that are valued in all strata. Therefore, this study analyses how different socioeconomic groups formulate their own answers regarding: what does health mean to you?, Design: Concept mapping procedures were performed in three groups that differ in educational level. All procedures followed exactly the same design., Setting: Area of the city of Utrecht, the Netherlands., Participants: Lay persons with a lower, intermediate and higher educational level (±15/group)., Results: The concept maps for the three groups consisted of nine, eight and seven clusters each, respectively. Four clusters occurred in all groups: absence of disease/disabilities, health-related behaviours, social life, attitude towards life. The content of some of these differed between groups, for example, behaviours were interpreted as having opportunities to behave healthily in the lower education group, and in terms of their impact on health in the higher education group. Other clusters appeared to be specific for particular groups, such as autonomy (intermediate/higher education group). Finally, ranking ranged from a higher ranking of the positively formulated aspects in the higher education group (eg, lust for life) to that of the negatively formulated aspects in the lower education group (eg, having no chronic disease)., Conclusion: Our results provide indications to suggest that people in lower socioeconomic groups are more likely to show a conceptualisation of health that refers to (1) the absence of health threats (vs positive aspects), (2) a person within his/her circumstances (vs quality of own body/mind), (3) the value of functional (vs hedonistic) notions and (4) an accepting (vs active) attitude towards life., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

This study identified previously reported facilitators and barriers to pharmacist-client communication and then evaluated their impact on the observed communication behaviors of pharmacists. Pharmacists (n = 100) completed a seven-page questionnaire collecting information on 11 variables that had been organized according to the Policy, Regulatory and Organizational Constructs in Educational and Ecological Development (PROCEDE) model as predisposing, enabling, or reinforcing of pharmacist communication with their clients. Demographic variables also were included. "Communication quality" served as the study's dependent variable, whereas pharmacist responses served as the independent variables. Communication quality scores for each pharmacist were obtained from the analysis of 765 audiorecordings of verbal exchanges occurring between the study pharmacists and their consenting clients during 4-hour, on-site observation periods. Four of the variables examined in the study were found to share a unique relationship with communication quality (pharmacists' attitude, year of graduation, adherence expectations, and outcome expectations). Hierarchical multiple regression analysis revealed that the variables measured in the questionnaire accounted for 23% of the variance in communication quality scores. Plausible explanations for why the study was unable to capture more of the variance in its proposed relationships and future areas for research are provided.

Burden among family caregivers has yet to be adequately assessed relative to social desirability response sets. This study examined the impact of two different response biases relative to expressed burden among spousal caregivers of suspected dementia patients. In addition to individual social desirability, it was hypothesized that a distinct social desirability construct exists as a function of one's perception of self within relationships. As predicted, a significant inverse association was apparent between expressed burden and this systemic response bias (as measured by the Edmonds Marital Conventionality Scale), whereas this association was not apparent with a measure of individual social desirability (the Marlowe-Crowne Social Desirability Scale). This finding suggests that systemic social desirability may exist as a significant response bias.